Differential Prognostic Effect of Revascularization According to a Simple Comorbidity Index in High‐Risk Non–ST‐Segment Elevation Acute Coronary Syndrome

Media type: E-Article
Title: Differential Prognostic Effect of Revascularization According to a Simple Comorbidity Index in High‐Risk Non–ST‐Segment Elevation Acute Coronary Syndrome
Contributor: Palau, Patricia; Núñez, Julio; Sanchis, Juan; Husser, Oliver; Bodí, Vicente; Núñez, Eduardo; Miñana, Gema; Boesen, Line; Ventura, Silvia; Llàcer, Angel
Published: Wiley, 2012
Published in: Clinical Cardiology, 35 (2012) 4, Seite 237-243
Language: English
DOI: 10.1002/clc.20996
ISSN: 0160-9289; 1932-8737
Keywords: Cardiology and Cardiovascular Medicine ; General Medicine
Origination:
Footnote:
Description: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background:</jats:title><jats:p>Data on the effect of revascularization on outcome in patients with high‐risk non–ST‐segment elevation acute coronary syndrome (NSTEACS) and significant comorbidities are scarce. Recently, a simple comorbidity index (SCI) including 5 comorbidities (renal failure, dementia, peripheral artery disease, heart failure, and prior myocardial infarction [MI]) has shown to be a useful tool for risk stratification. Nevertheless, therapeutic implications have not been derived.</jats:p></jats:sec><jats:sec><jats:title>Hypothesis:</jats:title><jats:p>We sought to evaluate the prognostic effect attributable to revascularization in NSTEACS according the SCI score.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>We included 1017 consecutive patients with NSTEACS. The effect of revascularization on a combined end point of all‐cause mortality or nonfatal MI was evaluated by Cox regression according to SCI categories.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>A total of 560 (55.1%), 236 (23.2%), and 221 (21.7%) patients showed 0, 1, and ≥2 points according to the SCI, respectively. Coronary angiography was performed in 725 patients (71.5%), and 450 patients (44.3%) underwent revascularization. During a median follow‐up of 16 months (interquartile range, 12–36 months), 305 (30%) patients experienced the combined end point (202 deaths [19.9%] and 170 MIs [16.7%]). In multivariate analysis, a differential prognostic effect of revascularization was observed comparing SCI ≥2 vs 0 (<jats:italic>P</jats:italic> for interaction = 0.008). Thus, revascularization was associated with a greater prognostic benefit in patients with SCI ≥2 (hazard ratio [HR]: 0.51, 95% confidence interval [CI]: 0.29–0.89), <jats:italic>P</jats:italic> = 0.018), whereas no significant benefit was observed in those with 0 and 1 point (HR: 1.31, 95% CI: 0.88–1.94, <jats:italic>P</jats:italic> = 0.171 and HR: 1.11, 95% CI: 0.70–1.76, <jats:italic>P</jats:italic> = 0.651, respectively).</jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p>In NSTEACS, the SCI score appears to be a useful tool for identifying a subset of patients with a significant long‐term death/MI risk reduction attributable to revascularization. © 2011 Wiley Periodicals, Inc.</jats:p><jats:p>This study was supported by a grant from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, RED HERACLES (FEDER) RD06/0009/1001 (Madrid, Spain). The authors have no other funding, financial relationships, or conflicts of interest to disclose.</jats:p></jats:sec>
Access State: Open Access

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